Water Birth: The Benefits and Risks of Water Birth

Delivering your baby in a tub of warm water is often nicknamed “the gentlest of gentle births”. Throughout television, movies, and other popular culture, birth can be depicted as a horribly painful event that involves a lot of medication, screaming, and agony on behalf of the mother. In response to this often violent depiction of one of the most natural aspects of a woman’s life, many women are beginning to look for alternative birthing methods, especially those that appear gentler for both the mother and the baby. Choosing a water birth suits many of these women’s needs.

What Exactly Is a Water Birth?

This term, water birth, applies when either your entire labor, delivery, or both, occur in water. For most women, they will labor in the water and then leave the water to actually deliver the child, but many choose to push their new little one out into the world through the water as well. One of the major theories behind a water birth is that since the amniotic sac that a baby is grown in rests at about 98 degrees, being born into a tub of water that is the same temperature will help to reduce fetal stress. Reducing fetal stress can help to reduce fetal complications as well. This also helps to make the transition from the fluid filled amniotic sac into the outside world much less jarring. More and more midwives, doulas, birthing centers, and even obstetricians are accepting this line of thought.

Water births can occur in several settings. Most women choose to deliver in a designated birthing facility or in a hospital if a birthing tub is available. Others choose this method and combine it with a home birth.

Why Choose a Water Birth?

Water births are becoming more and more popular with expecting mothers for several reasons.

-Control: Choosing a water birth can give you the feeling of having more control over your birth plan and labor. In addition, as water births are usually “natural” births, meaning done without pain medication, many women choose this method because it feels more natural.

-Pain relief and mobility: The warm water in which a water birth occurs can have several positive effects on the delivery experience of some expecting mothers. If experiencing severe contractions or the intense pain that occurs with back labor, the warmth of the water can help soothe a laboring mother’s sore muscles. Additionally, moving around and staying mobile during labor can be difficult, and even changing positions can sometimes not help to relieve the pain. That is where the tub of water comes in. Having a laboring mother float in the water helps take all of the weight and pressure of her body off her joints and back. This helps increase mobility, flexibility, and just gives the mother’s body a rest from all of the hard work it is doing.

-Energy: In late stages of labor, water has also been shown to increase your energy levels. Being able to relax and focus on the actual labor and not just your discomfort can help give you a boost in energy. This is especially helpful if you are in late stage labor, as you need all the energy you can get to make it through those last few moments before your baby is born.

-Relieves stress: Not only does water birth help to decrease the stress of the baby and ease its transition into the world, but it can also help relieve your stress and anxiety as well! Warm water and floating in the water have been shown to help lower the anxiety levels of expecting mothers, making their bodies more receptive to the delivery. This also in turn reduces the high blood pressure that can occur from anxiety. This reducing of stress means that the body can produce more endorphins to help combat the pain signals in the body. Being submerged in a tub of water can give a greater sense of privacy as well, which will also help reduce stress levels.

-Less tearing: Laboring in warm water can also help reduce the amount of damage done to your body during labor. The water has been shown to soften the perineum and cause it to become more elastic. This makes the muscles more relaxed and flexible, which can reduce the likelihood that you will experience tearing during delivery or need an episiotomy.

-Improved oxygen: Floating in the water and having your body become buoyant can also help promote uterine contractions that are more efficient. These contractions combined with the floating increase the amount of oxygen being pumped through your blood and promotes better circulation. This means that there is less pain for the mother, more oxygen for the baby, and more oxygen reaching the uterine muscles.

When Is a Water Birth Not a Great Choice?

While many women do choose a water birth and report great satisfaction with it, there are several times in which you should consider another birthing method.

-Infectious diseases: If you have herpes or another infectious genital disease, it is not a good idea to use water. Herpes is especially contagious in water and can transfer easily from you to the baby, or you to the health care provider if he or she is in the tub with you.

-Multiples: If you are having multiples, it may not be a well-advised decision to use a water birth. While women have been able to deliver multiples in water, the timing can be difficult. The goal is to remove the baby from the water quickly so as to avoid it breathing in the water, but with multiples, there may not be time to safely handle this portion of the birth.

-Breech: If your child is breech and will not be guided into the correct position, a water birth is not advised.

-Patient history: If you have a history of bleeding disorders, or if pre-term labor is expected, a water birth is not recommended. Bleeding might be more severe in a tub as the warmth might cause more circulation, and with a pre-term baby, the lungs may not be developed enough to handle the water should the baby breathe any water in. This also applies to patients with toxemia or preeclampsia, as these are serious conditions that need to be monitored more closely.

-Meconium: If you are producing a large amount of meconium, you will probably be asked to leave the water to deliver the baby outside of the tub. A small to moderate amount is to be expected, but too much can cause issues for the delivery. The midwife or doctor might be able to scrape it off the surface of the water, and often times any meconium that is on the baby will come off in the water. However, it can still cause the water to be thicker, and make it more dangerous if the baby breathes any of it into its lungs.

-Fetal or maternal distress: If fetal or maternal distress is detected, you will either be asked to leave the water and deliver in a more traditional method, or you may be taken for an emergency C-section.

-Slow labor: if your labor is progressing too slowly, or has stopped, your midwife or doctor might encourage you to get out of the tub and move around the room. Sometimes the water in the tub may relax the baby too much and slow down labor and motion is needed to get the process started again.

Misconceptions about Water Births

So now that you have read why women might or might not choose a water birth, you might have some questions. Unfortunately, due to its reputation as a “hippie” method to deliver a baby, many misconceptions surround water births.

Isn’t a water birth more painful? The answer to this misconception is that it depends on the individual woman with her individual labor. However, the majority of women who try this method claim that it helps to cut their pain in half, if not more. Also, due to the benefits listed above, the water helps release endorphins in your brain, which will help your body cope with the pain, and the buoyancy can ease the pain on your joints.

Water births are dirty. This common misconception seems like it would make sense. You are after all floating in water, expelling your pregnancy fluids, and many women worry they might poop while in the water. However, despite almost half of all mothers pooping in the tub while in labor, the rate of infection in the newborns is less than .01 percent. This is because many doctors believe the water dilutes the bacteria, and the water forms a natural sort of barrier over the skin of the newborn before the baby is lifted out.

Warmer water is better. This major misconception can be dangerous and lead to fetal distress. While it is true that the baby has lived the last 40 weeks of its life in 98-degree water, the water must never be any higher than that. Too warm of water can lead to fetal distress as the baby can become dehydrated. To avoid this you should stay as hydrated as possible and check the water’s temperature consistently.

Won’t my baby drown? This is probably the biggest misconception and fear that women have about delivering in water. However, if you think about it, the baby is already an aquatic creature to begin with. The baby has spent the last nine months developing in its own personal swimming pool. It has received all of its oxygen from its umbilical cord, which continues to function in the same method after the baby is born. It is only when the baby is lifted out of the water into the air that its body switches from receiving air through the placenta and instead the baby inhales air into its lungs. In addition, it should be noted that infants have a biological trait called the bradycardic response. The bradycardic response makes an infant who is underwater immediately and instinctively hold its breath and open its eyes. This helps keep the baby from breathing in the water.

What Happens during a Water Birth?

If you have decided that water birth is the method for you, or are simply still curious about how the process works, look no further. Here we will discuss how a water birth is carried out and what it is like to deliver in this fashion.

One of the first keys to a successful water birth is successful planning. If you feel as if this might be the right method for you, you should first contact your chosen health care provider to make sure he or she is comfortable with the procedure and if it is even a possibility. There may not be a birthing tub available, but he or she might know of a birthing facility that does. If a birthing tub is not available you might then discuss with your health care provider the possibility of a water birth at home, or about potentially renting a birthing tub.

Throughout your labor you might find yourself entering and reentering the water several times. Getting into the water too soon can help ease the pain of labor, but might also potentially slow down labor as the warmth might relax muscles too much. Many hospitals, midwives, and doctors may also ask you to wait to enter the water until you are 5 cm or more dilated in the period of active labor. You may also choose to have your partner or other loved one join you in the water. If the tub is too small, or your partner is uncomfortable, it is still recommended to have your partner stand or sit close to you, and help soothe any discomfort you may have. More often than not, the midwife or doctor will not climb into the tub with you, but instead will monitor you closely from the edge of the tub. However, this often depends on the midwife or doctor.

Once you are in the tub, there are several ways in which you could position yourself to better facilitate birth. You could try squatting, kneeling, or choose to rest in the tub with your head or upper body supported by a pillow on the edge. You can also try to simply float in the water, helping take the pressure off your body, which can help you focus more on visualizing the delivery. During this process, the lights will normally be dimmed to help create a cozier atmosphere. The dim lights will also be less jarring for your baby once it has decided to join the world. If you need to use the restroom while in the tub, you will be able to get in and out, but be sure to wrap up in warm towels upon leaving the toilet, as the shift in temperature can be harsh for the baby.

During the labor and delivery process while you are relaxing, and focusing on bringing your child into the world, the midwife or doctor will be hard at work. He or she will be assisting you with getting in and out of the tub, monitoring the temperature of the water as well as the cleanliness, and monitoring your contractions. The midwife or doctor will also be monitoring your labor progression and taking your vitals frequently. In addition to your part of the labor, the midwife or doctor will also monitor your baby’s heartbeat and check for signs of fetal distress. The midwife or doctor will also check your dilation. Most importantly, your doctor or midwife will be there to cheer you on, especially when labor might become more painful or more difficult. When your baby is finally born, the midwife or doctor will ensure that the baby is lifted out of the water gently and in the right position so as to keep the baby from breathing in any water. This will be done slowly and gently and only after the baby’s entire body has been born. This keeps the baby from overriding its bradycardic response, and ensures that the umbilical cord will not snap from being pulled on too quickly or too hard.

Once your baby has been born and pulled out of the water you might be surprised at how calm the baby appears to be. Many women and midwives report that babies who are born in water are far calmer than their born-in-air counterparts are. The midwife or doctor will then gently guide your baby into your arms where you can hold him or her against your chest in skin-to-skin contact. As long as you keep most of the baby’s body submerged in the water, there is no need to bundle him or her up, and you can even choose to breastfeed right away. Some women may choose to deliver their placenta in the tub as well, but if not, you simply need to leave the tub, and wrap yourself and the baby in warm, dry towels and relax in the birthing room until your placenta has been delivered.

Congrats! You have just delivered a baby in “the most gentle of gentle” ways. Many women choose a water birth for the many benefits and experiences that arise from it, and if this is a method that speaks to you, we encourage you to discuss it further with your health care provider so you can make a well-informed decision.